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There is a huge difference between having a mental illness and being legally insane. The legally insane are not responsible for their crimes because they were incapable of knowing what they did was wrong (due to mental illness). But the vast majority (99 of people with mental illness are not legally insane. Even a large majority of people with schizophrenia-the mental illness that most severely messes with your reality testing-are not legally insane, and are responsible for their actions.